Pain in the Achilles tendon is common in both active individuals and those who exercise very little. So common, and been around so long that it is mentioned in Greek mythology! The tendon is located in the back of the ankle, acting as the attachment of the calf muscles to the heel bone. Like many other tendon problems, an injury here can stem from overuse or degeneration (the gradual breakdown of connective tissue).
With tendinitis, the feeling may be that of a mild burning, prickly sensation or dull ache in the Achilles tendon, about 1 to three inches above the heel bone. That part of the tendon is susceptible to injury or degeneration due to a poor blood supply. As the problem worsens, the pain may be described as a shooting, stabbing sensation, especially during physical activity. A crackling sensation may sometimes be felt while rubbing the tendon with fingers, indicating inflammatory fluid is probably present.
If the tendon becomes weak, a partial or complete tear(rupture) can occur. At that point, the person may feel a sudden snap or pop, sometimes believing that someone has kicked them. Sometimes, there is very little pain, but swelling develops. A torn Achilles will cause obvious weakness when attempting to stand on ones toes or “push off” with the foot.
Achilles tendon irritation can be caused by something as simple as the back of the shoe rubbing against it. On the other hand, damage can be caused by repetitive overstretching while running or walking. If flexibility and conditioning in that part of the body is not optimal, the tendon gradually loses its ability to tolerate the stress of body weight with each step. The best prevention is a flexibility and strengthening program for the calf and ankle area. Like most overuse injuries, a gradual increase in training volume and intensity is also one of the best ways to "stay out of trouble". Try not to increase volume or intensity by more than 10% per week. Your heart and lungs may be able to take it, but your achilles may yell at you!
Treatment for Achilles tendon problems begins with self-care. This can include gentle stretching, ice application, and use of over-the-counter anti-inflammatory medication. Some practitioners even recommend the latest dietary supplement used for arthritis: glucosamine. Professional care should be sought if the symptoms do not resolve after two weeks, or if an obvious, persistent limp is present. Your health care professionals may prescribe special exercises, rest, physical therapy, and possibly medication. Other treatments include heel lifts, shoe orthotics, and night splints. Surgery may be required if excessive scar tissue has formed or if a complete rupture is present. After that, a gradual program of rehabilitation would be needed.
Tony Oliveri, M.S.,P.T.
